Inside Health

Personal Health

By Jane E. Brody

Published: January 22, 1992

THE side effects of chemotherapy have become a fact of life for millions of Americans as cancer researchers continue to demonstrate the life-saving potential of an ever-growing list of cell-killing drugs.

For many cancer patients who feel relatively well at the time their disease is discovered, the nausea and vomiting, hair loss, fatigue and other debilitating symptoms often associated with chemotherapy can make the treatment seem far worse than the disease, at least in cancer's early stages. For some, the side effects of cancer-fighting drugs are so distressing that they abandon the therapy and, in doing so, often sacrifice their only chance for a lasting cure.

It is important for patients to know and for doctors to explain that in more than 90 percent of patients, side effects of chemotherapy can be significantly reduced or avoided.

Because they are unaware of the many tricks of the trade now available for minimizing the side effects of established chemotherapeutic drugs, patients may be lured to fringe therapists, many of whom are neither doctors nor experts on the complexities of cancer.

Some patients may seek out unproven "alternative" therapies that are said to be free of chemotherapy's toxic effects, like special diets and supplements, "cleansing" enemas, mental gymnastics or cell therapies said to increase the body's ability to fight off the cancer.

And while many patients shun chemotherapy because they overestimate its debilitating effects, others are prompted to quit the drug treatments because they had not expected the side effects and did not realize they could be ameliorated.

Some oncologists, concerned about unduly frightening prospective chemotherapy patients, do not tell them enough about the potential complications of treatment. But even when doctors are forthcoming, studies show that many patients fail to hear, comprehend or remember what they are told about side effects because of their emotional state. Why Chemotherapy?

A generation ago, chemotherapy was used only as a last-ditch effort when other primary cancer treatments, namely surgery or radiation, failed to produce a cure. The treatments often made patients even sicker than they already were and, because their cancers were usually well advanced when the drugs were given, most patients died anyway. The effect was to give chemotherapy a bad name in the minds of most of the people who could now benefit from it.

For several cancers, for example the leukemias and testicular cancer, chemotherapy is now recognized as the most effective and sometimes the only route to cure. For other cancers, chemotherapy is an adjunct, given either as an essential part of the primary therapy or as the clean-up hitter after primary therapy.

Today chemotherapy is playing an ever-larger role as the mop for cancer cells that may escape the surgeon's knife or the radiologist's beam and lurk in hidden regions of the body where they could seed a recurrence months or years later. For example, chemotherapy is now widely recommended for many women with breast cancer even when surgery seems to have removed the entire cancer and there has been no spread to the lymph nodes. Such women treated for at least six months with a combination of anticancer drugs are more likely to remain alive and free of cancer for a decade or more than are women treated with surgery alone. Fighting Side Effects

All drugs capable of killing cancer cells can also attack normal cells, and this accounts for much of chemotherapy's unpleasant side effects.

The strategy in administering anticancer drugs is to maximize the effect on the cancer while minimizing the attack on normal tissue, often by using combinations. One drug, for example, may be toxic to nerve cells, another to heart muscle, another to bone marrow. Another approach is to schedule treatments or adjust the dosage so that normal tissue, but not the cancer, is able to recover from the drug assault before the next round is begun. A third method is to try to protect normal tissue from attack or to apply further treatment to ameliorate the unwanted effects.

Many patients think incorrectly that the side effects of chemotherapy must be endured if the drugs are going to cure their disease. As a result, they fail to inform their oncologists about discomforts that might be reduced or eliminated.

Following are some common side effects of cancer chemotherapy and ways to combat them:

*Nausea and vomiting. Depending on the cancer, from 40 to 80 percent of chemotherapy patients experience either or both. Nausea often quickly becomes a conditioned response to therapy such that patients' stomachs flip-flop as soon as they enter the clinic. This side effect can often be reduced or eliminated by antiemetic drugs (including marijuana and ondansetron, or Zofran); "desensitization" therapy involving deep relaxation; acupuncture, and dietary manipulation. While chemotherapy is exacting its harshest toll, nutritionists recommend a diet high in protein and carbohydrates consumed in small amounts as often as possible, and plenty of fluids between meals.